AccountId: 011433970860
ContactId: ff341871-af07-4374-8719-04793bca90d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 270010 ms
Total Talk Time (AGENT): 140392 ms
Total Talk Time (CUSTOMER): 64892 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/ff341871-af07-4374-8719-04793bca90d7_20250110T17:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is So[PII]How may I assist you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hi, I was calling to verify benefits for a patient for ambulatory surgery center.
[AGENT][POSITIVE] OK, sure. I can assist you with benefits. And may I have your name?
[CUSTOMER][NEUTRAL] Br[PII].
[AGENT][NEUTRAL] OK. And Miss Br[PII]may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's 95[PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, it's 0248311.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 0248311 is missing one digit.
[CUSTOMER][NEUTRAL] Hm, I have no clue. That's all I have. That's all they gave me. Can you look at it by their name?
[AGENT][NEUTRAL] Mm, OK. Um, what is the spelling of the last name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] P [PII].
[AGENT][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 42[PII]OK. And what is the spelling of the first name?
[CUSTOMER][NEUTRAL] Um it's Y [PII].
[AGENT][NEUTRAL] [PII]eah, OK, thank you. Let me check.
[AGENT][NEUTRAL] Alright this number.
[AGENT][NEUTRAL] OK, may I have his date of birth?
[CUSTOMER][NEUTRAL] Yes, it's 10[PII].
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] And you said you need outpatient benefits, correct? All right. OK, and that's gonna be 31 in the end instead of 2.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, and before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And this is one of our secondary supplemental plan to the major medical. And let's see. OK, with this one, we have an outpatient maximum, let's see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Where outpatient.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Let me double check on this one. It's not giving me an outpatient maximum.
[AGENT][POSITIVE] Inpatient, that's impatient, that's impatient. OK.
[AGENT][NEUTRAL] OK, so it is a combined benefit inpatient outpatient. Um, so it looks like the combined benefit is for inpatient and outpatient is 9100 per covered person per calendar year.
[CUSTOMER][NEUTRAL] So that's how much they're covered up until is the $9100?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and do you know how much they've accumulated already?
[AGENT][NEUTRAL] OK, um, more than likely to have not used the benefits because it started all over again this year, um, but I can check just to make sure. Mhm, yes, uh, so let me go back to it one moment.
[CUSTOMER][NEUTRAL] Oh, OK. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, they have not used their benefits for 20[PII]s of today, so they still have the full amount available. Is there anything else I can help you with today, Ms. Br[PII]?
[CUSTOMER][NEUTRAL] No, can you just tell me if prior authorization would be required for them?
[AGENT][NEUTRAL] No, we're just the secondary.
[CUSTOMER][POSITIVE] Perfect and may I have your name?
[AGENT][NEUTRAL] My name is So[PII]That's S [PII].
[CUSTOMER][POSITIVE] Perfect, and may I have a call reference number as well please?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] Perfect thank you have a great day.
[AGENT][POSITIVE] You're welcome, Miss B [PII]n the USO and thank you for calling APL. Bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.